PLANTAR FASCIITIS – HEEL PAIN; WHAT ARE YOUR TREATMENT OPTIONS?
Plantar fasciitis is the most common cause of heel pain. It can be incredibly painful and quite honestly, it sucks!
We constantly see clients with this problem and the symptoms may have started last week or started 5 years ago.
What does it feel like?
Odds are if you clicked on this blog then you probably already know 😟
Most people describe the pain as being at its worst first thing in the morning when getting out of bed.
It can be anywhere from 2/10 to 10/10.
Typically, after the first 15 to 30 minutes the pain will start to ease and be the best it will be all day.
If you sit down for any longer than about 20 minutes and go to stand back up, the pain can return.
This will often be as painful as when you first got out of bed or close to.
At the end of the day you sit down to rest for 20 minutes, but dread the idea of getting up for a cup of tea.
What is it?
Plantar fasciitis is inflammation of the plantar fascia. What does that mean?
Your plantar fascia is a ligamentous band which runs between your heel on your forefoot.
I find below the easiest way to explain this.
- Picture of fillet steak
- The white casing on the outside is fascia. The stuff which is hard to cut with Blunt knife.
- We have a 2 to 4mm band of that material running from our heel to our forefoot.
What is the role of your plantar fascia?
Your plantar fascia is like the suspension cables in a bridge. It helps prevent the arch of your foot dropping down to far.
The bones in our feet look a little similar to the design of a key stone bridge.
These are the old style bridges where if you take out the centre block, the bridge will collapse.
In your foot the centre block is your navicular and there are other structures which help maintain your arch.
However in some cases these structures start to fatigue and more stress is placed on your plantar fascia.
It is really important to know that your plantar fascia is the last line of defence when your arch is dropping down.
So when it starts to get sore there are other things going on as well.
Why does it happen?
There are two main reasons why people get plantar fasciitis.
- If you have a sudden or direct trauma to the area which results in damage to the plantar fascia, such as playing netball after having a 2 year hiatus.
- You have a progressive overload to the plantar fascia which causes it to weaken and get injured, such as altered foot function.
Sudden or direct trauma(rare)
It should be something like jumping off the second story building onto concrete.
In sport, it can be caused by a very sudden stop when running or massive acceleration from a standing start, such as in football. Usually, you will be able to feel pain instantly and can remember the moment the pain started.
Progressive overload – too much pressure, for too long
This is what the vast majority of clients experience. One of the major challenges with plantar fasciitis is determining the main reason for this issue, and it’s our job to figure out what that is.
Here is a list of some of the known factors to cause plantar fasciitis:
- Weight –The more weight you carry, the more pressure put through your feet
- Activity – The more activity you do, the more pressure you place upon you plantar fascia when exercising
- Pregnancy –The sudden weight gain during pregnancy can lead to increased strain on your plantar fascia
- Tibialis posterior dysfunction –This is basically the technical way of saying the muscle that sits at the back of your shin bone starts getting tired and stops lifting up your arch.
- Hypermobility – If your joints move further or more than normal, your muscles need to stabilize the action. Eventually, your muscles can become tired and stop doing their role, which increases the strain on the plantar fascia.
- Flat feet/ pronation – If you have low arches, then the plantar fascia becomes excessively stretched and strained.
- High arches/ supinated foot type – It is rarer for this to cause plantar fasciitis, however in some cases this occurs as the foot can pronate late in you gait (walking) pattern.
- Tight calves – Your calf muscles don’t just attach onto the back of your heel, but go underneath the heel as well, which can result in pulling on your plantar fascia. It can also force your foot to have a early heel lift when walking, which also strains the plantar fascia
- Increased time on your feet – The longer you spend on your feet the more likely you are to cause strain to your plantar fascia. The more load put on something, the more likely it is to fail.
- Bad footwear – Footwear makes a HUGE difference to plantar fasciitis. Your once good footwear can also wear out and need to be replaced. Here is a link to what we look for in shoes – click here for more information on correct features of a shoe
- Weak intrinsic foot muscles – We have a lot of different small muscles in our feet and like all muscles, they can get fatigued. When they do we get increased pressure on the plantar fascia.
When it comes to plantar fasciitis it is not a hard diagnosis to get to. If you type into Google ‘heel pain’ you should be sorted! However, when you visit a podiatrist, we assess for are the causes to help explain why it’s happening so that we can get rid of your pain.
At the clinic will ask you a number of questions about
- When did it start?
- How painful?
- Has anything helped?
- What shoes do you wear?
- What sort of work do you do?
And a bunch more to try to find out a little more about what factors could be causing it.
We will do a standing assessment of your feet as well as a gait assessment, which involves watching you walk.
This will help us see how your foot function may be contributing to your pain.
After this will perform some muscle testing as well as palpating/pressing along your legs and feet to help establish if any other structures are involved.
The aim of treatment is reduce as many of the risk factors as we can whilst also providing the right environment for the plantar fascia to heal.
When it comes to plantar fasciitis, there is no shortage of treatment options.
The main issue becomes which ones do we choose.
Here’s a brief outline of a few options.
Stretching – Typically the main areas that you looking to stretch is your calf muscles to reduce pressure from your Achilles on the base of the heel.
Strengthening – This involves increasing the strength of the supporting muscles, such as the muscles within the foot and tibialis posterior.
Massage – This can be quite effective in reducing pain and also increasing the healing process.
This can be performed with a tennis ball, golf ball, lacrosse ball etc.
A harder ball usually works best as it provides a deeper massage, however you can use whatever you can tolerate.
Frozen water bottle massage – It’s a great one to do at home and can really help out with the first step in the morning.
At the clinic we sell an item called a Pediroller which goes in the freezer and do the same job, except it typically doesn’t skid across the floor as much.
Orthotics – The aim behind orthotic therapy is to help control your foot motion so that there is less strain placed upon your plantar fascia.
When there is less pressure, it allows the region to heal and can also take some of the pressure off supporting muscles of the feet.
Shockwave therapy – This treatment is designed to help with healing and often has patients leaving the clinic feeling as though they are ‘walking on air’.
It involves the use of a probe which sends localised shockwaves into the plantar fascia to help reduce inflammation and can even break down scar tissue.
Depending on the patient, it can take 3-6 treatments performed a week apart.
Shockwave is used in conjunction with other treatments including orthotics and stretching.
Night splints – The aim of these splints is to stretch the plantar fascia and the calves while you sleep and may help with first step pain when you wake up in the morning.
These are often used in conjunction with other therapies to be used throughout the day including orthotics.
PRP injections – Platelet-rich plasma injections can be used to treat a range of musculoskeletal issues including plantar fasciitis.
Essentially, it involves an injection of the patient’s own blood which has a high platelet count in order to assist with soft tissue healing.
Prolotherapy – Designed to help restore injured tissue, prolotherapy involves an injection into the affected area in an attempt to strengthen the tissue and reduce pain.
Cortisone injections – Cortisone helps to reduce swelling and inflammation of the plantar fascia and can be extremely beneficial in terms of pain relief. Cortisone injections are often used in conjunction with other treatments including orthotics.
Trigger point dry needling – This treatment is similar to acupuncture, whereby very thin needles are injected into various tissues in order to help with relieving tight structures.
A ‘myofascial trigger point’ or area of tight muscle fibres is identified and a needle is inserted into the muscle.
Needling of the calves often helps relieve pain in patients with plantar fasciitis.
Acupuncture – Similarly to trigger point dry needling, acupuncture involves the insertion of fine needles.
Acupuncture is based on traditional chinese acupuncture, whereby the insertion of the needle is based on energy forces rather than myofascial trigger points.
Surgery – Surgery is often the last resort when treating plantar fasciitis and is almost always reserved for extreme cases.
Surgery involves cutting part of the plantar fascia to help relieve stress and tension.
There are risks associated with surgery, therefore we will usually try other treatments before sending patients for a surgical consult.
Compression – Compression provides support for inflamed structures and can be very therapeutic for those with plantar fasciitis.
It helps reduce swelling and promote blood flow which is required to help heal injured tissues.
Activity modification – A very important part of the healing process is allowing the injured structures to rest by taking load off.
Activity modification may be required to avoid placing excessive pressure on the plantar fascia, however we never want our patients to stop exercising all together!
Footwear changes – Footwear plays a huge role in plantar fasciitis.
The plantar fascia is responsible for helping to maintain your arch, therefore if you are constantly wearing shoes that are not very supportive, the plantar fascia has to work twice as hard to support your foot.
Super flexible shoes or shoes with a flat, thin sole are often the main culprits.
Here is a blog on picking the right shoes for you – https://www.watsoniapodiatry.com.au/idea-perfect-shoe-actually-perfect/
Taping – Taping can provide support to the plantar fascia by decreasing the load placed upon it.
If your foot structure is the cause of your plantar fasciitis pain, taping can help manipulate the joints of the foot to decrease the stress on the plantar fasciitis.
Taping is also a good tool to decide on other treatment options, as it mimics the effect of orthotics.
Rocktape application – Rocktape works by helping to reduce the strain of the plantar fascia and provide support. It is great in aiding proprioception for clients.
Mobilisation and manipulation – Mobilisation and manipulation of the joints within the foot can help to reduce the strain on the plantar fascia.
The plantar fascia runs between the heel bone and the ball of the foot, and there are a lot of little bones in between and surrounding it!
Ultrasound therapy – This involves sending localised sound waves into the plantar fascia providing pain relief and a decrease in inflammation.
It helps to promote blood flow which is needed to enable the plantar fascia to heal and is often used in addition to other treatments.
NSAIDs – Non-steroidal anti-inflammatory drugs such as panadol and nurofen can be used for pain relief in patients with plantar fasciitis.
It is important to check with your GP regarding which anti-inflammatory medication is appropriate for you.
Many people with blood pressure medications can have issues using this sort of medication.
There are no shortage of treatments for plantar fasciitis but it is really important to focus on the one that you can have the biggest impact for you.
How do we treat it at the clinic?
Everyone is different and therefore we individualise the treatment for each client.
People react differently to different treatments and we take that into consideration when creating the best treatment plan for you! At our clinic, we can help you with:
Stretching and strengthening programs – we use an online program called physiapp so you will always be able to access your exercises.
Frozen water bottle/ pediroller massage – Help get rid of some of the inflammation with the combination of cold and massage.
Here is a a link to a blog it’s use https://www.watsoniapodiatry.com.au/all-you-need-to-know-about-pedirollers/
Orthotic therapy – we can advise and customise preformed, semi-custom or custom orthotics depending on what is going to give you the best outcome. We adjust every pair of orthotics onsite for the correct fit.
Trigger point dry needling – An excellent for the particularly tight muscles which are hard to massage.
Advise on activity modification – Sometimes we need to slow down to heal, before we can speed up again.
Taping – We typically use taping as a trial for orthotics or those who will only need support for a short period of time
Mobilisation and manipulation – We use these methods when the joints of your feet are not moving correctly and we gently help improve their position and movement.
Sending for scans – As podiatrist we are able to send you for an X-ray and ultrasound which can be bulk billed at local radiology centers. This can help guide our treatment plans and evaluate the severity of the condition.
Night splints – Are very effective for people with tight calf muscles and can make great improvements to the first step pain.
Shockwave therapy – is often used in conjunction with other therapies for chronic cases.
We also have an extensive list of allied health professionals who we trust and are able to refer to should you require treatment that is not available at our clinic. This includes surgery, prolotherapy, PRP and cortisone injections.
Let us help you get that heel pain under control with a structured treatment plan for you!
You can give us a call on 94322689 or book online